Provider Demographics
NPI:1235267980
Name:DYAB, OMAR (DDS)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:DYAB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 OAK ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-3304
Mailing Address - Country:US
Mailing Address - Phone:530-528-3488
Mailing Address - Fax:
Practice Address - Street 1:343 OAK ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3304
Practice Address - Country:US
Practice Address - Phone:530-528-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123461223G0001X
CA589501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice